Aging and Long Term Care ( 3 Hours) > Chapter 4 - Psychological Aspects of Aging

Chapter 4 - Psychological Aspects of Aging

IV. Psychological Aspects of Aging

A. Depression and Other Emotional Issues

Depression in the aged is a significant problem. Changes in physical abilities, illnesses and diseases, the loss of loved ones, lack of a defining activity, lack of work can all contribute to significant depressive feelings. Without a feeling of some purpose, many will not feel like getting out of bed in the morning is worth it, and the depression can get worse along with poorer health.
The percentages of people with clinically relevant depressive symptoms, along with age groups are displayed in the following table:

Gender 65 and over 65-69 70-74 75-79 80-84 85 and over
Women 18 16 18 18 18 22
Men 11 10 10 10 15 15

Source: Health and Retirement Study 2002, Non-Institutionalized Population

Among those with relevant depressive symptoms are those who have severe symptoms which are associated with Major Depression. About 1%-2% of people 65 years and older have this disorder. The symptoms include the following:

  • Depressed mood most of the day, nearly every day for 2 weeks or longer and/or
  • Loss of interest or pleasure in activities the person usually enjoys

Other symptoms can include:

  • Significant weight loss or weight gain or changes in appetite
  • Trouble sleeping, waking very early, or sleeping too much
  • Feeling restless, "keyed up," and irritable
  • Fatigue, lack of energy, or feeling slowed down
  • Feelings of guilt, worthlessness, or hopelessness
  • Difficulty concentrating, remembering, or making decisions
  • Recurrent thoughts of death or suicide, suicide attempts

(Alexopoulos, et al. 2001)

Depression is very risky, not just for quality of life but for the potential of suicide. Untreated depression is the number one cause of suicide. The elderly are twice as likely as the general population to commit suicide, and white men are 5 times more likely to commit suicide. Depressive symptoms may also cause patients not to take good care of themselves. Medications may contribute to depressions as well as the various diseases associated with aging.

Depressive symptoms can be different in older adults than younger. Older adults often have a natural tendency for lower appetite and a change in sleep pattern. However, if the mood is depressed and withdrawn, and other symptoms show, then depression may be present. It is important to do a complete psychosocial assessment, which includes a history of depressive symptoms.

B. Treatment of Depression

Depression may be as a result of events (situational) or may have a more neurological cause or psychological cause. The elderly are at risk for situational depression because of the many losses they suffer (death of loved ones, loss of job, hearing impairment, memory impairment, independence, poor health, etc.) It is important to find out when the depressive symptoms started, how long they have lasted and how severe they are. You should also find out if there was a precipitating event. The presence of such an event can help direct treatment. The patient should also receive a complete medical examination to determine what illnesses may be contributing to the illness in addition to what medications may be contributing to the depressive symptoms.

The doctor will perform a complete physical examination, obtain laboratory tests, and assess mental status (ability to think clearly, remember, and make plans). The purpose of this workup is to determine if a medical condition or medication may be causing or contributing to the depression.

Treatment for depression can include cognitive-behavioral therapy (changing pessimistic thoughts and beliefs), supportive psychotherapy (providing emotional support to help the person cope with and resolve difficulties), problem-solving therapy (helps the person learn more effective ways to manage problems), and interpersonal therapy (works with the person to improve problems in relationships). Educating the person and their family about depression are also important interventions.
(Alexopoulos, et al. 2001)

Cognitive therapy is one of the more common therapies used to help with depression. If not contraindicated by a client's mental capacity, it can be effective in alleviating or minimizing the depressive symptoms. In cognitive restructuring the professional helps the client replace faulty thinking or misconceptions with beliefs and thoughts that are more aligned with reality and lead to enhanced functioning. The therapist helps people improve their self-dialogue and educates them that it is this inner dialogue that is affecting their depressed mood. In cases working with the elderly, much of the dialogue may be pessimistic and negative about the elderly person's life situation, and thoughts that their life has been a failure.

The following steps are useful in cognitive restructuring:
  • Assist clients to accept that their statements and beliefs affect their emotional reactions to life's events.
  • Assist clients to identify dysfunctional beliefs and patterns of thoughts that underlie their problems.
  • Assist clients to identify situations that engender dysfunctional cognitions.
  • Assist clients to substitute functional self-statements in place of self defeating cognitions.
  • Assist clients to reward themselves for successful coping efforts.

(Cormier and Cormier 1979)

For other guidelines in helping the elderly and their families with depression go to the following link: Depression LP Guide.pdf

C. Counter Transference Issues in Working with the Elderly

Working with the Elderly can be an emotionally draining experience. As a result of the different issues that the elderly are dealing with, often times they may lash out at the therapist because they are conveniently present, or they feel it is safe to be there. Sometimes there is a lot of complaining about situations out of the therapist's control whether it be present circumstances, family relationships or even paranoia causing the client to have suspicion of everyone around them. The therapist who becomes too emotionally involved or wants to be always pleasing can be taken for an emotional roller coaster and get "burned out." In addition, the therapist may have a relationship with a family member who is elderly, whether a parent, grandparents, or others close to them. The therapist must maintain an awareness of whatever feelings that might be brought into the therapeutic relationship.

Another emotional experience for the therapist working with the elderly is when a client passes away, either abruptly or resulting from a known terminal illness. This clientele can be both challenging and emotionally draining, but with a proper balance, can bring a great deal of satisfaction. With those clients who are terminally ill, engaging them in the therapeutic relationship and allowing them to express their feelings at their pace is important. "Being with them" and supporting the expression of feelings while also working with their families can be a very difficult, but also uplifting experience when a client and their loved ones are able to move through the steps of dying, and find acceptance and peace. Again, it is can be difficult for the practitioner to engage and support the client and their family through the process, and while managing personal emotions. Not every process will go well. In fact, if they are seeing a therapist, chances are there will be quite a roller coaster of emotions.


Question No.4. What percentage of older adults suffer from Major Depression?

a. 1-2%
b. 5-6%
c. 10-11%
d. 50%

Questions No.5. Symptoms of Major Depression include:

a. Mostly depressed mood for over 2 weeks
b. A hope for the future
c. Loss of interest in usual activities
d. Recurrent thoughts of death and suicide
e.Answers a, c and d

Questions No.6. White elderly men are five times more likely to commit suicide than the general population:

a. True
b. False

Aging and Long Term Care ( 3 Hours) > Chapter 4 - Psychological Aspects of Aging
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